Provider Demographics
NPI:1245335124
Name:BOWLES ORTHODONTIC SPECIALISTS PA
Entity type:Organization
Organization Name:BOWLES ORTHODONTIC SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:865-546-0792
Mailing Address - Street 1:309 CONCORD ST # C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3304
Mailing Address - Country:US
Mailing Address - Phone:865-546-0792
Mailing Address - Fax:865-546-0877
Practice Address - Street 1:309 CONCORD ST # C
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3304
Practice Address - Country:US
Practice Address - Phone:865-546-0792
Practice Address - Fax:865-546-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty